Materiały źródłowe

• #1

  https://www.nhs.uk/conditions/ankylosing-spondylitis/diagnosis/

  Ankylosing spondylitis (AS) can be difficult to diagnose because the condition develops slowly and there’s no definitive test. […] If your GP suspects AS, they may arrange blood tests to check for signs of inflammation in your body. […] If your results suggest you do have inflammation, you’ll be referred to a rheumatologist for further tests. […] If your results do not show inflammation, this may not rule out AS, and you might need more tests. […] Your rheumatologist will carry out imaging tests to examine the appearance of your spine and pelvis, as well as further blood tests. […] A genetic blood test may sometimes be carried out to see if you carry the HLA-B27 gene variant, which is found in most people with AS. […] This can contribute towards a diagnosis of AS, but it’s not entirely reliable as not everyone with the condition has this gene variant and some people have the gene variant without ever developing AS.

• #2 Ankylosing Spondylitis Tests: How Doctors Diagnose the Condition

  https://www.healthline.com/health/ankylosing-spondylitis/ankylosing-spondylitis-test

  Ankylosing spondylitis is a type of arthritis that primarily affects your spine and hips. It can be difficult to diagnose because there’s no single test that can provide enough information for a definitive diagnosis. […] Doctors use a combination of tests to make an ankylosing spondylitis diagnosis such as a physical exam, imaging tests, and blood tests. […] Blood tests can help rule out other conditions and check for signs of inflammation suggestive of ankylosing spondylitis. Blood tests alone can’t provide enough evidence to diagnose ankylosing spondylitis, but they can provide supportive evidence along with the results of imaging tests. […] A genetic blood test may also be used to see if you carry the HLA-B27 gene. […] Imaging tests can examine commonly affected areas such as your spine and pelvis to look for signs of ankylosing spondylitis such as joint fusion, erosion, extra bone formation (syndesmophyte and osteophyte), and calcification.

• #3 Diagnostic Delay in Ankylosing Spondylitis: Related Factors and Prognostic Outcomes | Volume 31 – Issue 1 – March 2016 | Archives of Rheumatology

  https://archivesofrheumatology.org/full-text/770

  Objectives: This study aims to evaluate diagnostic delay, factors which are related to diagnostic delay, and the effect of diagnostic delay on prognostic outcomes in terms of spinal and hip mobility, functional status, disease activity, quality of life, cervical rotation, tragus to wall distance, and sacroiliitis severity in an Iranian population with ankylosing spondylitis (AS). […] Diagnostic delay was mean 7.887.17 years. […] Negative HLA-B27, enthesitis, and low educational level are factors which affect diagnostic delay in AS. Individuals with enthesitis or low educational level should be evaluated accurately without causing delay in diagnosis since longer delay may lead to poorer prognostic outcomes. […] Delayed diagnosis has been suggested as one of the several factors affecting the prognostic outcomes in AS.

• #4 Diagnostic Delay in Ankylosing Spondylitis: Related Factors and Prognostic Outcomes | Volume 31 – Issue 1 – March 2016 | Archives of Rheumatology

  https://archivesofrheumatology.org/full-text/770

  The longer the delay is in diagnosis of AS, the poorer will be the quality of life and function, and the more severe will be the disease activity and limitation of spinal and hip mobility. Therefore, emphasis should be placed on to make earlier diagnosis and consequently begin on time appropriate treatment for better prognosis in patients with AS.

• #5 What type of doctor gives a diagnosis for Ankylosing Spondylitis? | SPONDYLITIS.ORG

  https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/ankylosing-spondylitis/diagnosis/

  A rheumatologist is commonly the type of physician who will diagnose ankylosing spondylitis (AS), since they are doctors who are specially trained in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments, connective tissue, and bones. A thorough physical exam, including X-rays, individual medical history, and a family history of AS, as well as blood work (including a test for HLA-B27) are factors in making a diagnosis. […] Note that AS can present differently at onset in some people. This tends to be the case in women more than men. Quoting Dr. Elaine Adams, Women often present in a little more atypical fashion so its even harder to make the diagnosis in women. For example, we have heard anecdotally from some women with AS that their symptoms started in the neck rather than in the lower back.

• #6

  https://link.springer.com/article/10.1007/s10067-016-3231-z

  The current study sought to identify the health care providers who make the diagnosis of AS in patients with chronic back pain in the USA, to assess treatment and referral patterns, and to identify factors associated with diagnostic delay in a large sample of patients who initially presented in non-rheumatology settings including primary care. […] The median time from back pain diagnosis to rheumatologist referral was 307 (interquartile range 81782) days, and median time from referral to AS diagnosis was 28 (interquartile range 0194) days. […] Only one third of patients with AS with a recorded diagnosis of chronic back pain were referred to rheumatologists before a diagnosis of AS was made. […] Improved awareness of AS signs and symptoms in the primary care setting may lead to more timely and appropriate rheumatology referrals and subsequently accurate diagnosis and appropriate treatment.

• #7

  https://link.springer.com/article/10.1007/s10067-016-3231-z

  This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. […] Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. […] The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. […] The delay between symptom onset and diagnosis of ankylosing spondylitis (AS) has been estimated at approximately 8 to 11 years in Europe and approximately 13 years in the USA. […] Strategies for appropriate and timely referral to rheumatologists aimed at shortening the diagnostic delay in AS have been described.

• #8

  https://link.springer.com/article/10.1007/s10067-016-3231-z

  The current study sought to identify the health care providers who make the diagnosis of AS in patients with chronic back pain in the USA, to assess treatment and referral patterns, and to identify factors associated with diagnostic delay in a large sample of patients who initially presented in non-rheumatology settings including primary care. […] The median time from back pain diagnosis to rheumatologist referral was 307 (interquartile range 81782) days, and median time from referral to AS diagnosis was 28 (interquartile range 0194) days. […] Only one third of patients with AS with a recorded diagnosis of chronic back pain were referred to rheumatologists before a diagnosis of AS was made. […] Improved awareness of AS signs and symptoms in the primary care setting may lead to more timely and appropriate rheumatology referrals and subsequently accurate diagnosis and appropriate treatment.

• #9 Ankylosing Spondylitis: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/ankylosing-spondylitis/diagnosis-treatment-and-steps-to-take

  To diagnose ankylosing spondylitis, your doctor will ask you about your medical history and perform a physical exam. Your doctor may order imaging studies and lab tests to help confirm a diagnosis. […] Your doctor may order imaging studies to help diagnose ankylosing spondylitis: X-rays help doctors see joint changes. However, you may have the disease for years before the changes show on x-rays. Doctors may use x-rays to monitor the progression of the disease or to rule out other causes for the joint pain. […] Magnetic resonance imaging (MRI) uses energy from a powerful magnet to produce signals that create a series of cross-sectional images. These images or slices are analyzed by a computer to produce an image of the joint. MRI can help diagnose ankylosing spondylitis in the early stages of the disease.

• #10 What type of doctor gives a diagnosis for Ankylosing Spondylitis? | SPONDYLITIS.ORG

  https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/ankylosing-spondylitis/diagnosis/

  The overall points taken into account when making an AS diagnosis are: Onset is usually under 45 years of age. Pain persists for more than three months (i.e., it is chronic). Back pain and stiffness worsen with immobility, especially at night and early morning. Back pain and stiffness tend to ease with physical activity and exercise. […] A physical examination entails looking for sites of inflammation. Thus, your doctor will likely check for pain and tenderness along the back, pelvic bones, sacroiliac joints, chest, and heels. During the exam, your doctor may also check for limitations in spinal mobility in all directions and for any restriction of chest expansion. […] Other symptoms and indicators are also taken into account, including a history of iritis or uveitis (inflammation of the eye), a history of gastrointestinal infections (for example, the presence of Crohns Disease or ulcerative colitis), and a family history of AS, as well as fatigue due to the presence of inflammation.

• #11 Ankylosing spondylitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/diagnosis-treatment/drc-20354813

  During the physical exam, your health care provider might ask you to bend in different directions to test the range of motion in your spine. Your provider might try to reproduce your pain by pressing on specific portions of your pelvis or by moving your legs into a particular position. You also may be asked to take a deep breath to see if you have difficulty expanding your chest. […] X-rays allow doctors to check for changes in joints and bones, also called radiographic axial spondyloarthritis, though the visible signs of ankylosing spondylitis, also called axial spondyloarthritis, might not be evident early in the disease. […] Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to provide more-detailed images of bones and soft tissues. MRI scans can reveal evidence of nonradiographic axial spondyloarthritis earlier in the disease process, but they are much more expensive.

• #12 What type of doctor gives a diagnosis for Ankylosing Spondylitis? | SPONDYLITIS.ORG

  https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/ankylosing-spondylitis/diagnosis/

  The overall points taken into account when making an AS diagnosis are: Onset is usually under 45 years of age. Pain persists for more than three months (i.e., it is chronic). Back pain and stiffness worsen with immobility, especially at night and early morning. Back pain and stiffness tend to ease with physical activity and exercise. […] A physical examination entails looking for sites of inflammation. Thus, your doctor will likely check for pain and tenderness along the back, pelvic bones, sacroiliac joints, chest, and heels. During the exam, your doctor may also check for limitations in spinal mobility in all directions and for any restriction of chest expansion. […] Other symptoms and indicators are also taken into account, including a history of iritis or uveitis (inflammation of the eye), a history of gastrointestinal infections (for example, the presence of Crohns Disease or ulcerative colitis), and a family history of AS, as well as fatigue due to the presence of inflammation.

• #13 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Differential Diagnoses

  https://emedicine.medscape.com/article/332945-differential

  The Assessment of SpondyloArthritis International Society (ASAS) has developed criteria for the classification of axial and peripheral SpA. […] ASAS classification criteria for axial SpA are as follows: Back pain for 3 months or longer, Age at onset 45 years, Sacroiliitis on imaging (plain radiographs or MRI) plus one or more SpA features or HLA-B27 plus two or more other SpA features. […] The first set consists of one or more of the following: Psoriasis, Inflammatory bowel disease, Preceding infection, Sacroiliitis on imaging (radiographs or MRI). […] The second set consists of two or more of the following: Arthritis, Enthesitis, Dactylitis, Past history of inflammatory back pain, Positive family history of SpA. […] The New York criteria for the diagnosis of AS, which are based on clinical and radiographic findings, include the following: Limitation of motion of the lumbar spine in all 3 planes, History of pain or presence of pain at the thoracolumbar junction or in the lumbar spine, Limitation of chest expansion to 1 inch or less, as measured at the fourth intercostal space. […] The disease progression is a gradual process, and the grading is somewhat subjective.

• #14 Ankylosing spondylitis – Wikipedia

  https://en.wikipedia.org/wiki/Ankylosing_spondylitis

  Ankylosing spondylitis is a member of the more broadly defined disease axial spondyloarthritis. […] Diagnosis is based on symptoms with support from medical imaging and blood tests. […] While AS can be diagnosed through the description of radiological changes in the sacroiliac joints and spine, there are currently no direct tests (blood or imaging) to unambiguously diagnose early forms of ankylosing spondylitis (non-radiographic axial spondyloarthritis). Diagnosis of non-radiologic axial spondyloarthritis is therefore more difficult and is based on the presence of several typical disease features. […] These diagnostic criteria include: Inflammatory back pain: Chronic, inflammatory back pain is defined when at least four out of five of the following parameters are present: (1) Age of onset below 40 years old, (2) insidious onset, (3) improvement with exercise, (4) no improvement with rest, and (5) pain at night (with improvement upon getting up). Pain often subsides as the day progresses with movement being of importance to alleviate the joint stiffness.

• #15 Ankylosing spondylitis – Wikipedia

  https://en.wikipedia.org/wiki/Ankylosing_spondylitis

  Ankylosing spondylitis is a member of the more broadly defined disease axial spondyloarthritis. […] Diagnosis is based on symptoms with support from medical imaging and blood tests. […] While AS can be diagnosed through the description of radiological changes in the sacroiliac joints and spine, there are currently no direct tests (blood or imaging) to unambiguously diagnose early forms of ankylosing spondylitis (non-radiographic axial spondyloarthritis). Diagnosis of non-radiologic axial spondyloarthritis is therefore more difficult and is based on the presence of several typical disease features. […] These diagnostic criteria include: Inflammatory back pain: Chronic, inflammatory back pain is defined when at least four out of five of the following parameters are present: (1) Age of onset below 40 years old, (2) insidious onset, (3) improvement with exercise, (4) no improvement with rest, and (5) pain at night (with improvement upon getting up). Pain often subsides as the day progresses with movement being of importance to alleviate the joint stiffness.

• #16 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  No laboratory test is diagnostic, but results can increase suspicion for the disorder or rule out other disorders that can simulate ankylosing spondylitis. […] If, after these tests, ankylosing spondylitis is still suspected, patients should undergo radiography or MRI of the lumbosacral spine and sacroiliac joints; demonstration of sacroiliitis on radiograph strongly supports the diagnosis. […] Although there are several existing diagnostic criteria for patients with suspected ankylosing spondylitis, the Assessment of SpondyloArthritis international Society (ASAS) criteria are most often applied. […] Diagnosis can be done using ASAS imaging or clinical criteria. […] To fulfill the imaging criteria, patients must have radiographic or MRI evidence of sacroiliitis plus at least 1 spondyloarthritis feature.

• #17 Ankylosing Spondylitis: Causes, Treatment | HSS Rheumatology

  https://www.hss.edu/condition-list_ankylosing-spondylitis.asp

  There is no single definitive laboratory test to confirm an ankylosing spondylitis diagnosis, but various lab tests are employed to detect signs of an inflammatory process (for example, the sedimentation rate may be elevated as a sign of inflammation in AS). A blood test for the presence of an HLA-B27 gene marker can be helpful, but the diagnosis is made by a combination of history, exam, lab and imaging studies.

• #18 Ankylosing Spondylitis Diagnosis: Path to Diagnosis | MySpondylitisTeam

  https://www.myspondylitisteam.com/resources/spondylitis-the-path-to-diagnosis

  Diagnosis may also involve blood tests or imaging procedures such as X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) scans. Scans allow the doctor to check for joint damage during diagnosis, and later measure how the disease progresses over time. […] Although no lab test is conclusive for spondylitis, blood test results provide important clues that make a spondylitis diagnosis seem more likely or help rule it out. […] Blood can be tested for the presence of a specific gene, HLA-B27, which is present in many people with spondylitis. The presence of HLA-B27 increases the likelihood of spondylitis, especially in people of European descent.

• #19 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  Ankylosing spondylitis is the prototypical spondyloarthropathy and a systemic disorder characterized by inflammation of the axial skeleton, large peripheral joints, and digits; nocturnal back pain; morning back stiffness; accentuated kyphosis; constitutional symptoms; aortitis; cardiac conduction abnormalities; and anterior uveitis. Diagnosis requires showing sacroiliitis on imaging or spine inflammation using MRI. […] Ankylosing spondylitis should be suspected in patients, particularly young men, with nocturnal back pain plus prolonged morning stiffness and kyphosis, diminished chest expansion, Achilles or patellar tendinitis, or unexplained anterior uveitis. A first-degree relative with ankylosing spondylitis should raise suspicion. […] Patients should generally be tested with erythrocyte sedimentation rate, C-reactive protein, and complete blood count.

• #20 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  To fulfill the clinical criteria, patients must have HLA-B27 plus at least 2 separate spondyloarthritis features. […] Historical features that distinguish inflammatory back pain from noninflammatory back pain include onset at 40 years, gradual onset, morning stiffness, improvement with activity, and duration of symptoms 3 months before seeking medical attention. […] Erythrocyte sedimentation rate and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients with active ankylosing spondylitis. […] The earliest abnormalities on radiographs are pseudo-widening caused by subchondral erosions, followed by sclerosis or later narrowing and eventually fusion in the sacroiliac joints. […] Changes typical of ankylosing spondylitis may not become visible on radiographs for years. MRI shows changes earlier, but there is no consensus regarding its role in routine diagnosis given the lack of prospective, validated data in regard to its diagnostic utility. […] Pelvic MRI should be done if the index of suspicion of spondyloarthritis is high or if there is a need to rule out other causes of the patient’s symptoms.

• #21 Ankylosing Spondylitis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/ankylosing-spondylitis/

  Currently, no laboratory test is diagnostic of the condition, which is one of the challenges with early diagnosis. Testing for the HLA-B27 is only recommended in certain clinical situations. […] MRI and computed tomography (CT) are more sensitive than radiography in the early identification of inflammation of joints, osteitis, cartilage changes, and edema in sacroiliitis. They can be utilized if radiographs are negative in a patient with clinical signs of ankylosing spondylitis. […] Diagnosis of ankylosing spondylitis in the early stages is only possible by combining imaging with the clinical findings.3,4 […] Although low back pain is one of the primary symptoms of ankylosing spondylitis, most back pain is unrelated to ankylosing spondylitis. […] There are currently no diagnostic laboratory tests for ankylosing spondylitis which limits early detection. However, MRI and CT are more sensitive than radiography in the early identification of inflammation of joints, osteitis, cartilage changes, and edema in sacroiliitis.

• #22

  https://www.nhs.uk/conditions/ankylosing-spondylitis/diagnosis/

  Ankylosing spondylitis (AS) can be difficult to diagnose because the condition develops slowly and there’s no definitive test. […] If your GP suspects AS, they may arrange blood tests to check for signs of inflammation in your body. […] If your results suggest you do have inflammation, you’ll be referred to a rheumatologist for further tests. […] If your results do not show inflammation, this may not rule out AS, and you might need more tests. […] Your rheumatologist will carry out imaging tests to examine the appearance of your spine and pelvis, as well as further blood tests. […] A genetic blood test may sometimes be carried out to see if you carry the HLA-B27 gene variant, which is found in most people with AS. […] This can contribute towards a diagnosis of AS, but it’s not entirely reliable as not everyone with the condition has this gene variant and some people have the gene variant without ever developing AS.

• #23 Ankylosing Spondylitis: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/ankylosing-spondylitis/diagnosis-treatment-and-steps-to-take

  At this time, no single test diagnoses ankylosing spondylitis. Your doctor may order a blood test to check for the HLA-B27 gene, which is present in most people with the disease. You may have the HLA-B27 gene and never develop ankylosing spondylitis, but it can give doctors more information when making a diagnosis. Your doctor may also order labs to check blood counts and markers of inflammation, which may help to give your doctor a sense of the extent of disease.

• #24 Diagnosis and Treatment of Ankylosing Spondylitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38371049/

  Ankylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the axial bone and sacroiliac joints. […] The dagger sign and sacroiliitis on radiographs, in particular, are crucial for diagnosis. Early inflammatory alterations can be found using modern diagnostic tools such as MRI, and the HLA-B27 gene can help confirm the diagnosis. Overall, 80-95% of people with AS have the HLA-B27 marker.

• #25

  https://www.healio.com/clinical-guidance/ankylosing-spondylitis/laboratory-findings-presentation-and-diagnosis

  There is no specific diagnostic or pathognomonic laboratory marker for ankylosing spondylitis/axial spondyloarthritis (AS/axSpA), and diagnosis is based on clinical history, physical examination and imaging findings. […] Elevated ESR and CRP are more commonly found in AS patients with peripheral arthritis than in those with only axial disease. […] Their clinical utility is relatively limited because of their suboptimal sensitivity and specificity; CRP is elevated in 50%-60% of the patients with AS and 30%-40% of the patients with non-radiographic axial spondyloarthritis (nr-axSpA) only. Thus, a normal value does not exclude the presence of axSpA. […] Measurement of CRP is preferred over ESR for clinical assessment and follow-up, and for calculating the Assessment of Spondyloarthritis International Society (ASAS)-endorsed disease activity score named Ankylosing Spondylitis Disease Activity Scores (ASDAS).

• #26

  https://www.healio.com/clinical-guidance/ankylosing-spondylitis/laboratory-findings-presentation-and-diagnosis

  There is no specific diagnostic or pathognomonic laboratory marker for ankylosing spondylitis/axial spondyloarthritis (AS/axSpA), and diagnosis is based on clinical history, physical examination and imaging findings. […] Elevated ESR and CRP are more commonly found in AS patients with peripheral arthritis than in those with only axial disease. […] Their clinical utility is relatively limited because of their suboptimal sensitivity and specificity; CRP is elevated in 50%-60% of the patients with AS and 30%-40% of the patients with non-radiographic axial spondyloarthritis (nr-axSpA) only. Thus, a normal value does not exclude the presence of axSpA. […] Measurement of CRP is preferred over ESR for clinical assessment and follow-up, and for calculating the Assessment of Spondyloarthritis International Society (ASAS)-endorsed disease activity score named Ankylosing Spondylitis Disease Activity Scores (ASDAS).

• #27 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Workup: Approach Considerations, Laboratory Studies, Radiography

  https://emedicine.medscape.com/article/332945-workup

  Radiographic studies are most helpful in establishing a diagnosis of ankylosing spondylitis (AS). […] European League Against Rheumatism (EULAR) guidelines for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice, issued in April 2015, recommend conventional radiography of the sacroiliac (SI) joints as the first imaging method to diagnose sacroiliitis as part of axial spondyloarthritis in the majority of cases. […] EULAR also recommends MRI of the SI joints for patients in whom clinical features and conventional radiography findings are not diagnostic, but axial spondyloarthritis is still suspected. […] EULAR does not generally recommend imaging modalities other than conventional radiography and MRI for diagnosing axial spondyloarthropathy. […] The diagnosis of AS is not dependent on laboratory data; no laboratory tests are specific for AS.

• #28 Ankylosing Spondylitis: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/ankylosing-spondylitis/diagnosis-treatment-and-steps-to-take

  To diagnose ankylosing spondylitis, your doctor will ask you about your medical history and perform a physical exam. Your doctor may order imaging studies and lab tests to help confirm a diagnosis. […] Your doctor may order imaging studies to help diagnose ankylosing spondylitis: X-rays help doctors see joint changes. However, you may have the disease for years before the changes show on x-rays. Doctors may use x-rays to monitor the progression of the disease or to rule out other causes for the joint pain. […] Magnetic resonance imaging (MRI) uses energy from a powerful magnet to produce signals that create a series of cross-sectional images. These images or slices are analyzed by a computer to produce an image of the joint. MRI can help diagnose ankylosing spondylitis in the early stages of the disease.

• #29 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/ankylosing-spondylitis/diagnosis.html

  Tests related to ankylosing spondylitis include: […] X-rays of the spine and pelvis. These tests can check for bone changes (bony erosions, fusion, or calcification of the spine and sacroiliac joints). Certain changes in the sacroiliac joint confirm the diagnosis of AS. But those changes can take several years to develop enough to show on an X-ray. […] Magnetic resonance imaging (MRI) and computed tomography (CT) scan are more sensitive than X-ray. If no changes to the sacroiliac joints show on the X-ray but your doctor still suspects AS, an MRI or CT scan may allow an earlier diagnosis. […] A genetic test may help show if you have a gene (HLA-B27) often linked with AS. Many people who have the HLA-B27 gene won’t get AS. So, having this test won’t confirm that you have the condition. But the test results can be helpful if your symptoms and physical exam haven’t pointed to a clear diagnosis.

• #30 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  To fulfill the clinical criteria, patients must have HLA-B27 plus at least 2 separate spondyloarthritis features. […] Historical features that distinguish inflammatory back pain from noninflammatory back pain include onset at 40 years, gradual onset, morning stiffness, improvement with activity, and duration of symptoms 3 months before seeking medical attention. […] Erythrocyte sedimentation rate and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients with active ankylosing spondylitis. […] The earliest abnormalities on radiographs are pseudo-widening caused by subchondral erosions, followed by sclerosis or later narrowing and eventually fusion in the sacroiliac joints. […] Changes typical of ankylosing spondylitis may not become visible on radiographs for years. MRI shows changes earlier, but there is no consensus regarding its role in routine diagnosis given the lack of prospective, validated data in regard to its diagnostic utility. […] Pelvic MRI should be done if the index of suspicion of spondyloarthritis is high or if there is a need to rule out other causes of the patient’s symptoms.

• #31 Diagnostic Tools in Ankylosing Spondylitis

  https://www.hcplive.com/view/diagnostic-tools-in-ankylosing-spondylitis

  However, it takes 7 to 10 years from the time the inflammatory back pain starts until those X-rays, on the average, turn positive. […] The use of MRI can be very useful in making an earlier diagnosis by demonstrating edema around the sacroiliac joints on MRI, which is indicative of inflammation. […] Other blood tests that we use to help in the following of the patients are the erythrocyte sedimentation rate, or sed rate, and C-reactive protein. […] Both of these are less useful in diagnosis but helpful in following the patient. […] Most recent studies suggest that having the C-reactive protein is better than the sedimentation rate. […] The problem with these blood tests is they miss about 50% of active patients, so theyre an imperfect way of following the disease and clearly demonstrate a need for better biomarkers.

• #32 Ankylosing spondylitis – Wikipedia

  https://en.wikipedia.org/wiki/Ankylosing_spondylitis

  If these criteria still do not give a compelling diagnosis magnetic resonance imaging (MRI) may be useful. […] MRI can show inflammation of the sacroiliac joint. […] The earliest changes demonstrable by plain X-ray shows erosions and sclerosis in sacroiliac joints. […] A drawback of X-ray diagnosis is the signs and symptoms of AS have usually been established as long as 7-10 years prior to X-ray-evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced. […] Options for earlier diagnosis are tomography and MRI of the sacroiliac joints, but the reliability of these tests is still unclear. […] Variations of the HLA-B gene increase the risk of developing ankylosing spondylitis, although it is not a diagnostic test.

• #33 Ankylosing spondylitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/ankylosing-spondylitis/

  Lower back pain for 3 months in patients of age and one of the following: Sacroiliitis confirmed on x-ray or MRI and 1 typical clinical or laboratory finding; A positive HLA-B27 test and 2 typical clinical or laboratory findings. […] CRP and ESR are typically elevated. […] HLA-B27: Positive in 90-95% of patients with axial spondyloarthritis. […] Early stages of AS may be unidentifiable on x-ray (low sensitivity for early-stage). Hence, a patient with several classical clinical and laboratory findings fulfills the diagnostic criteria for AS even if x-ray findings are inconclusive. […] MRI is the most sensitive method for early detection of inflammatory changes of AS. However, MRI is not routinely required to confirm a diagnosis of AS as specialized MRI techniques and radiology expertise is required to accurately identify AS findings. […] Characteristic findings include active inflammatory lesions: erosion of the sacroiliac joints and bone marrow edema (high signal intensity).

• #34 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  To fulfill the clinical criteria, patients must have HLA-B27 plus at least 2 separate spondyloarthritis features. […] Historical features that distinguish inflammatory back pain from noninflammatory back pain include onset at 40 years, gradual onset, morning stiffness, improvement with activity, and duration of symptoms 3 months before seeking medical attention. […] Erythrocyte sedimentation rate and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients with active ankylosing spondylitis. […] The earliest abnormalities on radiographs are pseudo-widening caused by subchondral erosions, followed by sclerosis or later narrowing and eventually fusion in the sacroiliac joints. […] Changes typical of ankylosing spondylitis may not become visible on radiographs for years. MRI shows changes earlier, but there is no consensus regarding its role in routine diagnosis given the lack of prospective, validated data in regard to its diagnostic utility. […] Pelvic MRI should be done if the index of suspicion of spondyloarthritis is high or if there is a need to rule out other causes of the patient’s symptoms.

• #35 Ankylosing Spondylitis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/ankylosing-spondylitis/

  It was later discovered that magnetic resonance imaging (MRI) could detect sacroiliitis years before abnormalities were visible on radiographs, which led to the ASAS to develop new criteria sets for axSpA in 2009 and for peripheral SpA in 2011 to better identify patients early and differentiate axial from peripheral disease.6 […] The most common initial symptom of AS is dull pain with insidious onset, typically felt deeply in the buttocks and/or in the lower lumbar regions, accompanied by morning stiffness that lasts for a few hours but improves with activity and returns with inactivity. […] For adults under age 45 with back pain lasting more than 3 months, the ASAS criteria states that a diagnosis of axial spondyloarthritis is confirmed if sacroiliitis is present on imaging in addition to at least 1 SpA feature or if HLA-B27 is present in addition to at least 2 other SpA features.14

• #36 Ankylosing Spondylitis – Zero To Finals

  https://zerotofinals.com/medicine/rheumatology/ankylosingspondylitis/

  Ankylosing spondylitis (AS) is an inflammatory condition affecting the axial skeleton (mainly the spine and sacroiliac joints), causing progressive stiffness and pain. […] Key investigations include: […] HLA B27 genetic testing […] Schober’s test assesses spinal mobility. […] A length of less than 20cm indicates a restriction in lumbar movement and helps support a diagnosis of ankylosing spondylitis. […] Inflammatory markers (e.g., CRP and ESR) may rise with disease activity […] X-ray of the spine and sacrum […] MRI of the spine can show bone marrow oedema early in the disease before there are any xray changes. […] A “bamboo spine” is the typical x-ray finding in the later stages of ankylosing spondylitis, where there is fusion of the sacroiliac and spinal joints. […] X-rays in ankylosing spondylitis can show:

• #37 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Differential Diagnoses

  https://emedicine.medscape.com/article/332945-differential

  The diagnosis of ankylosing spondylitis (AS) is generally made by combining clinical criteria of inflammatory back pain and enthesitis or arthritis with radiologic findings. […] Two sets of sensitive and specific criteria are available for diagnosis of spondyloarthropathy in general: (1) the European Spondyloarthropathy Study Group (ESSG) criteria and (2) the Amor criteria. […] Two other sets are used widely for diagnosis of AS: the New York criteria and the Rome criteria. […] A definite diagnosis of AS is met if there is (1) grade 3-4 bilateral sacroiliitis with at least 1 clinical criterion or (2) grade 3-4 unilateral sacroiliitis or grade 2 bilateral sacroiliitis with clinical criterion 1 or with both clinical criteria 2 and 3. […] A probable diagnosis of AS is made if grade 3-4 bilateral sacroiliitis exists without any signs or symptoms that satisfy the clinical criteria.

• #38 Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment

  https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/

  There is no consensus on the diagnosis of AS, but the 1984 Modified New York classification criteria has been generally accepted for both research and clinical purposes. It requires at least 1 clinical manifestation and at least 1 radiographic parameter. […] Because many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA. These recent criteria may aid clinicians in the diagnosis of axial SpA well before patients fulfill AS criteria by the 1984 Modified New York criteria. […] The ASAS criteria for axial SpA mandates patients have back pain for 3 months and be 45 years of age while fulfilling 1 of the following 2 sets of criteria: Set 1 Sacroiliitis on imaging* and 1 SpA feature** Set 2 HLA-B27 and 2 SpA features**.

• #39 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Differential Diagnoses

  https://emedicine.medscape.com/article/332945-differential

  The diagnosis of ankylosing spondylitis (AS) is generally made by combining clinical criteria of inflammatory back pain and enthesitis or arthritis with radiologic findings. […] Two sets of sensitive and specific criteria are available for diagnosis of spondyloarthropathy in general: (1) the European Spondyloarthropathy Study Group (ESSG) criteria and (2) the Amor criteria. […] Two other sets are used widely for diagnosis of AS: the New York criteria and the Rome criteria. […] A definite diagnosis of AS is met if there is (1) grade 3-4 bilateral sacroiliitis with at least 1 clinical criterion or (2) grade 3-4 unilateral sacroiliitis or grade 2 bilateral sacroiliitis with clinical criterion 1 or with both clinical criteria 2 and 3. […] A probable diagnosis of AS is made if grade 3-4 bilateral sacroiliitis exists without any signs or symptoms that satisfy the clinical criteria.

• #40 Diagnosis and management of ankylosing spondylitis | The BMJ

  https://www.bmj.com/content/333/7568/581

  Ankylosing spondylitis is a chronic inflammatory rheumatic disorder that primarily affects the axial skeleton. Sacroiliitis is its hallmark, accompanied by inflammation of the entheses (points of union between tendon, ligament, or capsule and bone) and formation of syndesmophytes, leading to spinal ankylosis in later stages. […] Because of its insidious nature, the diagnosis is sometimes delayed until late stages of the disease. […] The most commonly used criteria for the classification of ankylosing spondylitis were developed in 1966 and modified in 1984. They are: Low back pain of at least three months duration with inflammatory characteristics (improved by exercise, not relieved by rest), Limitation of lumbar spine motion in sagittal and frontal planes, Decreased chest expansion (relative to normal values for age and sex), Bilateral sacroiliitis grade 2 or higher, Unilateral sacroiliitis grade 3 or higher.

• #41 Diagnosis and management of ankylosing spondylitis | The BMJ

  https://www.bmj.com/content/333/7568/581

  Ankylosing spondylitis is a chronic inflammatory rheumatic disorder that primarily affects the axial skeleton. Sacroiliitis is its hallmark, accompanied by inflammation of the entheses (points of union between tendon, ligament, or capsule and bone) and formation of syndesmophytes, leading to spinal ankylosis in later stages. […] Because of its insidious nature, the diagnosis is sometimes delayed until late stages of the disease. […] The most commonly used criteria for the classification of ankylosing spondylitis were developed in 1966 and modified in 1984. They are: Low back pain of at least three months duration with inflammatory characteristics (improved by exercise, not relieved by rest), Limitation of lumbar spine motion in sagittal and frontal planes, Decreased chest expansion (relative to normal values for age and sex), Bilateral sacroiliitis grade 2 or higher, Unilateral sacroiliitis grade 3 or higher.

• #42 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Differential Diagnoses

  https://emedicine.medscape.com/article/332945-differential

  The Assessment of SpondyloArthritis International Society (ASAS) has developed criteria for the classification of axial and peripheral SpA. […] ASAS classification criteria for axial SpA are as follows: Back pain for 3 months or longer, Age at onset 45 years, Sacroiliitis on imaging (plain radiographs or MRI) plus one or more SpA features or HLA-B27 plus two or more other SpA features. […] The first set consists of one or more of the following: Psoriasis, Inflammatory bowel disease, Preceding infection, Sacroiliitis on imaging (radiographs or MRI). […] The second set consists of two or more of the following: Arthritis, Enthesitis, Dactylitis, Past history of inflammatory back pain, Positive family history of SpA. […] The New York criteria for the diagnosis of AS, which are based on clinical and radiographic findings, include the following: Limitation of motion of the lumbar spine in all 3 planes, History of pain or presence of pain at the thoracolumbar junction or in the lumbar spine, Limitation of chest expansion to 1 inch or less, as measured at the fourth intercostal space. […] The disease progression is a gradual process, and the grading is somewhat subjective.

• #43 Ankylosing Spondylitis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/ankylosing-spondylitis/

  It was later discovered that magnetic resonance imaging (MRI) could detect sacroiliitis years before abnormalities were visible on radiographs, which led to the ASAS to develop new criteria sets for axSpA in 2009 and for peripheral SpA in 2011 to better identify patients early and differentiate axial from peripheral disease.6 […] The most common initial symptom of AS is dull pain with insidious onset, typically felt deeply in the buttocks and/or in the lower lumbar regions, accompanied by morning stiffness that lasts for a few hours but improves with activity and returns with inactivity. […] For adults under age 45 with back pain lasting more than 3 months, the ASAS criteria states that a diagnosis of axial spondyloarthritis is confirmed if sacroiliitis is present on imaging in addition to at least 1 SpA feature or if HLA-B27 is present in addition to at least 2 other SpA features.14

• #44 Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy Differential Diagnoses

  https://emedicine.medscape.com/article/332945-differential

  The Assessment of SpondyloArthritis International Society (ASAS) has developed criteria for the classification of axial and peripheral SpA. […] ASAS classification criteria for axial SpA are as follows: Back pain for 3 months or longer, Age at onset 45 years, Sacroiliitis on imaging (plain radiographs or MRI) plus one or more SpA features or HLA-B27 plus two or more other SpA features. […] The first set consists of one or more of the following: Psoriasis, Inflammatory bowel disease, Preceding infection, Sacroiliitis on imaging (radiographs or MRI). […] The second set consists of two or more of the following: Arthritis, Enthesitis, Dactylitis, Past history of inflammatory back pain, Positive family history of SpA. […] The New York criteria for the diagnosis of AS, which are based on clinical and radiographic findings, include the following: Limitation of motion of the lumbar spine in all 3 planes, History of pain or presence of pain at the thoracolumbar junction or in the lumbar spine, Limitation of chest expansion to 1 inch or less, as measured at the fourth intercostal space. […] The disease progression is a gradual process, and the grading is somewhat subjective.

• #45 Ankylosing spondylitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808

  Ankylosing spondylitis has two types. When the condition is found on X-ray, it is called ankylosing spondylitis, also known as axial spondyloarthritis. When the condition can’t be seen on X-ray but is found based on symptoms, blood tests and other imaging tests, it is called nonradiographic axial spondyloarthritis. […] Seek medical attention if you have low back or buttock pain that came on slowly, is worse in the morning or awakens you from your sleep in the second half of the night particularly if this pain improves with exercise and worsens with rest. […] Ankylosing spondylitis can cause problems with the aorta, the largest artery in the body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function. The inflammation associated with ankylosing spondylitis increases the risk of heart disease in general. […] Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults.

• #46

  https://bpac.org.nz/BPJ/2016/July/spondyloarthritis.aspx

  Patients in the early stage of disease are classified as having non-radiographic axial spondyloarthritis. […] Research suggests that early diagnosis of axial spondyloarthritis improves patient outcomes, resulting in less pain and functional limitation, and may avoid unnecessary testing, treatment or referral. […] Testing CRP and HLA-B27 is appropriate for patients where there is a strong suspicion of axial spondyloarthritis. […] Radiographic imaging can detect changes consistent with ankylosing spondylitis, however, patients without radiographic changes may still have back pain due to early stage axial spondyloarthritis. […] For patients where there is a strong suspicion of axial spondyloarthritis, discussion with or referral to a rheumatologist is recommended as most will benefit from specialist assessment.

• #47

  https://www.nhs.uk/conditions/ankylosing-spondylitis/diagnosis/

  A diagnosis of AS can usually be confirmed if an X-ray shows inflammation of the sacroiliac joints (sacroiliitis) and you have at least 1 of the following: at least 3 months of lower back pain that gets better with exercise and doesn’t improve with rest, limited movement in your lower back (lumbar spine), limited chest expansion compared with what is expected for your age and sex. […] If an X-ray cannot confirm AS, you’ll usually be offered an MRI scan. […] If the MRI scan shows inflammation of the sacroiliac joints you’ll be diagnosed with non-radiographic axial spondyloarthritis. […] Sometimes inflammation does not show up on an X-ray or an MRI scan. In this case you might be diagnosed with non-radiographic axial spondyloarthritis if you have the HLA-B27 gene variant and have symptoms of the condition.

• #48

  https://www.nhs.uk/conditions/ankylosing-spondylitis/diagnosis/

  A diagnosis of AS can usually be confirmed if an X-ray shows inflammation of the sacroiliac joints (sacroiliitis) and you have at least 1 of the following: at least 3 months of lower back pain that gets better with exercise and doesn’t improve with rest, limited movement in your lower back (lumbar spine), limited chest expansion compared with what is expected for your age and sex. […] If an X-ray cannot confirm AS, you’ll usually be offered an MRI scan. […] If the MRI scan shows inflammation of the sacroiliac joints you’ll be diagnosed with non-radiographic axial spondyloarthritis. […] Sometimes inflammation does not show up on an X-ray or an MRI scan. In this case you might be diagnosed with non-radiographic axial spondyloarthritis if you have the HLA-B27 gene variant and have symptoms of the condition.

• #49

  https://www.nhs.uk/conditions/ankylosing-spondylitis/diagnosis/

  A diagnosis of AS can usually be confirmed if an X-ray shows inflammation of the sacroiliac joints (sacroiliitis) and you have at least 1 of the following: at least 3 months of lower back pain that gets better with exercise and doesn’t improve with rest, limited movement in your lower back (lumbar spine), limited chest expansion compared with what is expected for your age and sex. […] If an X-ray cannot confirm AS, you’ll usually be offered an MRI scan. […] If the MRI scan shows inflammation of the sacroiliac joints you’ll be diagnosed with non-radiographic axial spondyloarthritis. […] Sometimes inflammation does not show up on an X-ray or an MRI scan. In this case you might be diagnosed with non-radiographic axial spondyloarthritis if you have the HLA-B27 gene variant and have symptoms of the condition.

• #50 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  To fulfill the clinical criteria, patients must have HLA-B27 plus at least 2 separate spondyloarthritis features. […] Historical features that distinguish inflammatory back pain from noninflammatory back pain include onset at 40 years, gradual onset, morning stiffness, improvement with activity, and duration of symptoms 3 months before seeking medical attention. […] Erythrocyte sedimentation rate and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients with active ankylosing spondylitis. […] The earliest abnormalities on radiographs are pseudo-widening caused by subchondral erosions, followed by sclerosis or later narrowing and eventually fusion in the sacroiliac joints. […] Changes typical of ankylosing spondylitis may not become visible on radiographs for years. MRI shows changes earlier, but there is no consensus regarding its role in routine diagnosis given the lack of prospective, validated data in regard to its diagnostic utility. […] Pelvic MRI should be done if the index of suspicion of spondyloarthritis is high or if there is a need to rule out other causes of the patient’s symptoms.

• #51 Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis

  To fulfill the clinical criteria, patients must have HLA-B27 plus at least 2 separate spondyloarthritis features. […] Historical features that distinguish inflammatory back pain from noninflammatory back pain include onset at 40 years, gradual onset, morning stiffness, improvement with activity, and duration of symptoms 3 months before seeking medical attention. […] Erythrocyte sedimentation rate and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients with active ankylosing spondylitis. […] The earliest abnormalities on radiographs are pseudo-widening caused by subchondral erosions, followed by sclerosis or later narrowing and eventually fusion in the sacroiliac joints. […] Changes typical of ankylosing spondylitis may not become visible on radiographs for years. MRI shows changes earlier, but there is no consensus regarding its role in routine diagnosis given the lack of prospective, validated data in regard to its diagnostic utility. […] Pelvic MRI should be done if the index of suspicion of spondyloarthritis is high or if there is a need to rule out other causes of the patient’s symptoms.

• #52 What Is Ankylosing Spondylitis? Symptoms, Causes, Diagnosis, and Treatment

  https://www.everydayhealth.com/ankylosing-spondylitis/guide/

  Diagnosing Ankylosing Spondylitis […] Theres no single diagnostic test for ankylosing spondylitis. If your symptoms and medical history suggest you may have it, your doctor will likely do the following: […] Conduct a physical exam, including an exam of your spine and rib cage […] Order X-rays and possibly other imaging tests to look for bone or joint changes […] Order blood tests to look for inflammation and to rule out other forms of arthritis […] People with AS may be misdiagnosed with fibromyalgia, a chronic condition defined by pain and tenderness throughout the body that is often also associated with fatigue, anxiety, depression, sleep disturbances, and problems with memory or concentration. […] But the pain of fibromyalgia is not associated with tissue inflammation the way AS pain is. Additionally, a key feature of fibromyalgia is that the pain and other symptoms are not explained by another rheumatic or systemic disorder.

• #53 What Is Ankylosing Spondylitis? Symptoms, Causes, Diagnosis, and Treatment

  https://www.everydayhealth.com/ankylosing-spondylitis/guide/

  Nonetheless, the results of a survey reported in the journal Rheumatology and Therapy found that diagnosis delays and misdiagnoses are common among people with AS, and for women, especially, fibromyalgia is among the fairly common misdiagnoses. […] That being said, some people with AS also have fibromyalgia. A study found that one-third of patients with axial spondyloarthritis a form of spondyloarthritis in which the predominant symptom is back pain also have fibromyalgia syndrome. […] Its also been found that coexisting fibromyalgia in adults with inflammatory arthritis, including AS, tends to worsen the arthritis disease activity. […] Learn More About Diagnosing Ankylosing Spondylitis

• #54 What Is Ankylosing Spondylitis? Symptoms, Causes, Diagnosis, and Treatment

  https://www.everydayhealth.com/ankylosing-spondylitis/guide/

  Diagnosing Ankylosing Spondylitis […] Theres no single diagnostic test for ankylosing spondylitis. If your symptoms and medical history suggest you may have it, your doctor will likely do the following: […] Conduct a physical exam, including an exam of your spine and rib cage […] Order X-rays and possibly other imaging tests to look for bone or joint changes […] Order blood tests to look for inflammation and to rule out other forms of arthritis […] People with AS may be misdiagnosed with fibromyalgia, a chronic condition defined by pain and tenderness throughout the body that is often also associated with fatigue, anxiety, depression, sleep disturbances, and problems with memory or concentration. […] But the pain of fibromyalgia is not associated with tissue inflammation the way AS pain is. Additionally, a key feature of fibromyalgia is that the pain and other symptoms are not explained by another rheumatic or systemic disorder.

• #55 Diagnostic Delay in Ankylosing Spondylitis: Related Factors and Prognostic Outcomes | Volume 31 – Issue 1 – March 2016 | Archives of Rheumatology

  https://archivesofrheumatology.org/full-text/770

  Objectives: This study aims to evaluate diagnostic delay, factors which are related to diagnostic delay, and the effect of diagnostic delay on prognostic outcomes in terms of spinal and hip mobility, functional status, disease activity, quality of life, cervical rotation, tragus to wall distance, and sacroiliitis severity in an Iranian population with ankylosing spondylitis (AS). […] Diagnostic delay was mean 7.887.17 years. […] Negative HLA-B27, enthesitis, and low educational level are factors which affect diagnostic delay in AS. Individuals with enthesitis or low educational level should be evaluated accurately without causing delay in diagnosis since longer delay may lead to poorer prognostic outcomes. […] Delayed diagnosis has been suggested as one of the several factors affecting the prognostic outcomes in AS.

• #56 Diagnostic Delay in Ankylosing Spondylitis: Related Factors and Prognostic Outcomes | Volume 31 – Issue 1 – March 2016 | Archives of Rheumatology

  https://archivesofrheumatology.org/full-text/770

  Objectives: This study aims to evaluate diagnostic delay, factors which are related to diagnostic delay, and the effect of diagnostic delay on prognostic outcomes in terms of spinal and hip mobility, functional status, disease activity, quality of life, cervical rotation, tragus to wall distance, and sacroiliitis severity in an Iranian population with ankylosing spondylitis (AS). […] Diagnostic delay was mean 7.887.17 years. […] Negative HLA-B27, enthesitis, and low educational level are factors which affect diagnostic delay in AS. Individuals with enthesitis or low educational level should be evaluated accurately without causing delay in diagnosis since longer delay may lead to poorer prognostic outcomes. […] Delayed diagnosis has been suggested as one of the several factors affecting the prognostic outcomes in AS.

• #57 Diagnostic Delay in Ankylosing Spondylitis: Related Factors and Prognostic Outcomes | Volume 31 – Issue 1 – March 2016 | Archives of Rheumatology

  https://archivesofrheumatology.org/full-text/770

  The longer the delay is in diagnosis of AS, the poorer will be the quality of life and function, and the more severe will be the disease activity and limitation of spinal and hip mobility. Therefore, emphasis should be placed on to make earlier diagnosis and consequently begin on time appropriate treatment for better prognosis in patients with AS.

• #58 Can Ankylosing Spondylitis Be Misdiagnosed? | AS Diagnosis

  https://www.clinicbyclevelandclinic.com/blog/can-ankylosing-spondylitis-be-misdiagnosed/

  Receiving an accurate diagnosis is crucial when it comes to managing a complex condition like AS. If you have any concerns or doubts about your initial diagnosis, seeking a second opinion can provide clarity and reassurance. […] A second opinion may confirm or change your diagnosis of ankylosing spondylitis. Regardless, it can provide peace of mind and confidence that you can move forward knowing that you can get the care you need.

• #59

  https://bpac.org.nz/BPJ/2016/July/spondyloarthritis.aspx

  Patients in the early stage of disease are classified as having non-radiographic axial spondyloarthritis. […] Research suggests that early diagnosis of axial spondyloarthritis improves patient outcomes, resulting in less pain and functional limitation, and may avoid unnecessary testing, treatment or referral. […] Testing CRP and HLA-B27 is appropriate for patients where there is a strong suspicion of axial spondyloarthritis. […] Radiographic imaging can detect changes consistent with ankylosing spondylitis, however, patients without radiographic changes may still have back pain due to early stage axial spondyloarthritis. […] For patients where there is a strong suspicion of axial spondyloarthritis, discussion with or referral to a rheumatologist is recommended as most will benefit from specialist assessment.

• #60 10 Unusual Symptoms of Ankylosing Spondylitis

  https://www.verywellhealth.com/early-signs-of-ankylosing-spondylitis-5272183

  Because of the possibility of ankylosing spondylitis affecting lung function, smoking is contraindicated (advised against) for people who have this disease. […] Bowel problems can occur as a result of inflammation of the bowels and gastrointestinal tract before or after more common symptoms related to joint pain appear. […] Researchers concluded that a simple X-ray (radiograph) of sacroiliac joints and testing for the HLA-B27 gene can be useful, cost-effective, and avoid delays in diagnosing people with any clinical features of spondyloarthritis. […] Fatigue is considered relatively common in ankylosing spondylitis with an incidence of 50% to 70% of people who have the disease. […] Knowing how this disease can affect your body will help you notice its onset and avoid a delay in treatment. Getting care as early as possible to achieve the best outcomes and prevent severe damage.

• #61 Ankylosing Spondylitis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/ankylosing-spondylitis/

  Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder affecting the axial skeleton, peripheral joints, entheses, eyes, skin, and intestines and is characterized by inflammatory back pain, radiographic sacroiliitis, excess spinal bone formation, and a high prevalence of human leukocyte antigen (HLA)-B27.1,2 Clinical manifestations of ankylosing spondylitis include back pain, progressive spinal rigidity, and inflammation of the hips, shoulders, peripheral joints, and fingers or toes.3 […] Radiology for diagnostic and treatment purposes was first applied to ankylosing spondylitis in the 1920s. In the 1930s, physicians were able to use radiology to describe the early and late disease manifestations of ankylosing spondylitis; their descriptions are still used today to diagnose and stage the disease.3

• #62 Ankylosing Spondylitis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/ankylosing-spondylitis/

  It was later discovered that magnetic resonance imaging (MRI) could detect sacroiliitis years before abnormalities were visible on radiographs, which led to the ASAS to develop new criteria sets for axSpA in 2009 and for peripheral SpA in 2011 to better identify patients early and differentiate axial from peripheral disease.6 […] The most common initial symptom of AS is dull pain with insidious onset, typically felt deeply in the buttocks and/or in the lower lumbar regions, accompanied by morning stiffness that lasts for a few hours but improves with activity and returns with inactivity. […] For adults under age 45 with back pain lasting more than 3 months, the ASAS criteria states that a diagnosis of axial spondyloarthritis is confirmed if sacroiliitis is present on imaging in addition to at least 1 SpA feature or if HLA-B27 is present in addition to at least 2 other SpA features.14

• #63

  https://www.healio.com/clinical-guidance/ankylosing-spondylitis/laboratory-findings-presentation-and-diagnosis

  The presence or absence of HLA-B27 cannot establish or exclude the diagnosis of AS/axSpA because this test lacks 100% specificity and 100% sensitivity required to rule in or rule out associated disease. […] This test has demonstrated clinical utility in recognizing AS/axSpA in certain clinical situations. […] The value of the HLA-B27 test as one of the means used to help in search for a diagnosis of AS/axSpA depends on the individual pretest probability of the disease and the patients ethnicity and race. […] Laboratory testing for HLA-B27 and CRP levels help in the ASAS classification criteria for axSpA. […] Polygenic risk scores (PRS) has recently been reported to perform better than HLA-B27 testing and other standard tests employed in AS including CRP measurement and MRI scanning.

• #64 Diagnostic Tools in Ankylosing Spondylitis

  https://www.hcplive.com/view/diagnostic-tools-in-ankylosing-spondylitis

  The way that physicians, for several years, used to gauge activity in ankylosing spondylitis and axial spondyloarthritis is an instrument that was developed in the 1990s called the Bath Ankylosing Spondylitis Disease Activity Index, or the BASDAI, which is six questions that the patient fills out. […] A 4 out of 10 or greater is regarded as disease activity. […] The problem with the BASDAI is that it isnt very specific, in that patients with fibromyalgia will have very high BASDAI scores. […] They formulated the Ankylosing Spondylitis Disease Activity Score, or ASDAS. […] This takes into account three of the six questions from the BASDAI, as well as one patient global assessment on a visual analog scale of disease activity, and one objective test, either the C-reactive protein or the sed rate, and this will then factor in to a score. […] Its standardly used in clinical trials, and works pretty well in the clinical setting.

• #65 Ankylosing spondylitis – Wikipedia

  https://en.wikipedia.org/wiki/Ankylosing_spondylitis

  HLA-B27, demonstrated in a blood test, can occasionally help with diagnosis, but in itself is not diagnostic of AS in a person with back pain. […] The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), developed in Bath (UK), is an index designed to detect the inflammatory burden of active disease. […] The BASDAI can help to establish a diagnosis of AS in the presence of other factors such as HLA-B27 positivity, persistent buttock pain which resolves with exercise, and X-ray or MRI-evident involvement of the sacroiliac joints.

• #66 Diagnostic Tools in Ankylosing Spondylitis

  https://www.hcplive.com/view/diagnostic-tools-in-ankylosing-spondylitis

  The way that physicians, for several years, used to gauge activity in ankylosing spondylitis and axial spondyloarthritis is an instrument that was developed in the 1990s called the Bath Ankylosing Spondylitis Disease Activity Index, or the BASDAI, which is six questions that the patient fills out. […] A 4 out of 10 or greater is regarded as disease activity. […] The problem with the BASDAI is that it isnt very specific, in that patients with fibromyalgia will have very high BASDAI scores. […] They formulated the Ankylosing Spondylitis Disease Activity Score, or ASDAS. […] This takes into account three of the six questions from the BASDAI, as well as one patient global assessment on a visual analog scale of disease activity, and one objective test, either the C-reactive protein or the sed rate, and this will then factor in to a score. […] Its standardly used in clinical trials, and works pretty well in the clinical setting.

• #67 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/ankylosing-spondylitis/diagnosis.html

  The doctors in the Stanford Medicine Spine Center have the experience needed to accurately diagnose and effectively treat ankylosing spondylitis (pronounced „an-kil-OH-sing spawn-duh-LY-tus” and also known as AS). […] Our team includes doctors from orthopaedics, neurology, rheumatology, physiatry, and other specialties, working together to help ensure you receive an accurate diagnosis and the most effective treatment possible. […] Early, precise diagnosis and treatment may help reduce symptoms. Timely treatment also may reduce the risk of AS causing deformity to your spine or back. […] Your doctor will use your medical history, a physical exam, and an X-ray to diagnose AS. […] The clearest sign of the disease is a change in the sacroiliac joints at the base of the low back. This change can take up to a few years to show up on an X-ray.

• #68

  https://bpac.org.nz/BPJ/2016/July/spondyloarthritis.aspx

  Ankylosing spondylitis is a relatively uncommon inflammatory cause of long-term back pain which can result in radiographic changes in the spine and sacroiliac joints. […] Axial spondyloarthritis is an insidious disease and difficult to diagnose; patients have an average delay of eight years from the onset of symptoms to diagnosis. […] Diagnosis is aided by a family history, clinical examination, CRP, HLA-B27 testing and radiographic imaging. Imaging is usually reserved for patients with back pain of at least three months duration. […] Early diagnosis and treatment is beneficial. […] Various diagnostic criteria have been used for ankylosing spondylitis, with all relying on evidence of radiographic damage as a criterion for diagnosis. […] It is now recognised that patients in earlier stages of disease do not have radiographic changes, but share similar symptoms and signs, family history and genetic risk factors, and can experience disability as severe as some patients with a confirmed diagnosis of ankylosing spondylitis.

• #69 Ankylosing Spondylitis Diagnosis: Path to Diagnosis | MySpondylitisTeam

  https://www.myspondylitisteam.com/resources/spondylitis-the-path-to-diagnosis

  Spondylitis is typically diagnosed and treated by a rheumatologist a specialist in autoimmune and musculoskeletal diseases. However, most people with chronic (lasting for at least three months) low back pain go first to their primary care physician for help. Spondylitis is often misdiagnosed, or diagnosis is delayed especially when spondylitis symptoms are mild. […] Misdiagnosis and delayed diagnosis can delay treatment and allow spondylitis to progress, causing damage to joints. […] There is no one test that is conclusive for a diagnosis of spondylitis. Spondylitis is generally diagnosed through a combination of a physical examination, family history, blood tests, and imaging scans. The rheumatologist carefully considers many different test results before concluding that spondylitis is the correct diagnosis or ruling it out.

• #70 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/ankylosing-spondylitis/diagnosis.html

  The doctors in the Stanford Medicine Spine Center have the experience needed to accurately diagnose and effectively treat ankylosing spondylitis (pronounced „an-kil-OH-sing spawn-duh-LY-tus” and also known as AS). […] Our team includes doctors from orthopaedics, neurology, rheumatology, physiatry, and other specialties, working together to help ensure you receive an accurate diagnosis and the most effective treatment possible. […] Early, precise diagnosis and treatment may help reduce symptoms. Timely treatment also may reduce the risk of AS causing deformity to your spine or back. […] Your doctor will use your medical history, a physical exam, and an X-ray to diagnose AS. […] The clearest sign of the disease is a change in the sacroiliac joints at the base of the low back. This change can take up to a few years to show up on an X-ray.

• #71 Can Ankylosing Spondylitis Be Misdiagnosed? | AS Diagnosis

  https://www.clinicbyclevelandclinic.com/blog/can-ankylosing-spondylitis-be-misdiagnosed/

  Ankylosing spondylitis (AS), also called axial spondylarthritis, is an autoimmune condition affecting the spine or other joints. The condition causes joints and bones like vertebrae (the bones in your spine) to fuse together, causing mobility issues and pain. It can be hard to recognize because it often causes gradually worsening symptoms and has no definitive test, which can sometimes lead to ankylosing spondylitis being misdiagnosed. […] Several studies have estimated that the average diagnosis time for AS is around 5–7 years, which can feel like a lifetime when you’re living with severe pain and flare-ups. Back pain, especially lower back pain common with ankylosing spondylitis, is seen in many other conditions as well. This can make it challenging for doctors to pinpoint the cause and reach a proper diagnosis.

• #72 Ankylosing Spondylitis – Signs and Diagnosis | Dr. Badhan

  https://fcrheumatology.com/understanding-ankylosing-spondylitis-early-signs-and-diagnosis/

  Ankylosing spondylitis often goes undiagnosed for years, leading to prolonged discomfort and complications. […] Early detection and diagnosis are crucial to managing the symptoms effectively and improving the quality of life for those affected. […] Diagnosing ankylosing spondylitis involves a combination of medical history, physical examination, and diagnostic tests. […] Ankylosing spondylitis is diagnosed through a combination of medical history, physical examination, imaging tests like X-rays and MRIs, and blood tests to detect markers of inflammation and the HLA-B27 gene.

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